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1) K 1 1 A K T M 10 N I' <> I' T I \ 10 I N I' 10 K I <) K 

U: s. ueographowl and geological survey of the rocky moun 

VV . row Kl.l. IN ( ir'Ainii: 


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PEE11ISTO RI < ’ TR EP MINING 





CR A N [ AL A MRLETS 


ROBERT FLETCHER M. R. C. 8. Eng. 

ACT. ASST. SURGEON U. S ARMY 


[FROM CONTRIBUTIONS TO NORTH AMERICAN ETHNOLOGY VOL'. VI 























With Compliments of 


Dr. ROBERT FLETCHER. 


DEPARTMENT OF THE INTERIOR 
U. S. GEOGRAPHICAL AND GEOLOGICAL SURVEY OF THE ROCKY MOUNTAIN REGION 

J. W. POWELL in Charge 


ON 

PREHISTORIC TREPHINING 

AND 

CRANIAL AMULETS 


ROBERT FLETCHER M. R. C. S. Eng. 

ACT. ASST. SURGEON U. S. ARMY 



WASHINGTON 

GOVERNMENT PRINTING OFFICE 
1882 


























































































^ n 

■ .ft , 


LIST OF ILLUSTRATIONS. 


Page. 

Plate I.—Cranial amulets. 5 

II.—Cranium exhibiting surgical trephining.... 7 

III. —Crania showing effect of fracture and disease. 8 

IV. —Vertex of skull showing effect of saber-stroke.;. 10 

V.—Cranium exhibiting effect of early surgical trephining.. 11 

VI.—Cranium exhibiting both surgical and post-mortem trephining. 13 

VII.—The Inca skull from Peru. 24 

VIII.—Instruments for trephining used by the Kabyles. 26 

IX.—Cranium artificially trephined by M. Cliampionnifcre. 29 


i Y- 


Figure 1. — Perforated skull from Sable River, Michigan 
2.—Fragment from Kabyle skull.. 


24 

26 


























' 






























































































































































U. S. G. AND G. SURVEY. 


PREHISTORIC TREPHINING , PI. I. 




El 


Fig. 4. 

Figs. 1 and 2, The rondelle of Lyons. Fig. 3. An amulet from La Lozdro: A-B, the cicatrized edge from surgical 
trephining ; A-C, B-D, post-mortem sections. Fig. 4. A-B, cicatrized edge. Fig. 5. Amulet with groove for sus¬ 
pension. All natural size. (Broca.) 








ON PREHISTORIC TREPHINING AND CRANIAL AMULETS. 


BY ROBERT FLETCHER. 


Since the publication of Professor Broca’s interesting article on Cra¬ 
nial Amulets and Prehistoric Trephining, in 1877, 1 no connected account 
has been attempted, so far as the writer knows, of the additional discov¬ 
eries which have been reported. These are scattered through the journals 
on anthropology, and it would seem that a review of the whole subject;, 
commencing with a summary of Broca’s observations and arguments, and 
bringing together subsequent discoveries, would not only be of interest in 
•itself, but might result in more careful observation, leading perhaps to dis¬ 
coveries of a similar custom in America. 

The first communication upon the subject of cranial amulets, and which 
led to the discovery of evidence of prehistoric trephining, was made in 
August, 1873, by M. Pruni&res, at the meeting, at Lyons, of the French 
Association for the Advancement of Science. 2 M. Prunikres is well known 
for his researches in connection with the dolmens of La Loz&re. He 
exhibited to the association a piece of bone of an ovoid shape, 50 milli¬ 
meters by 38 in its two diameters. (See Plate I, figs. 1 and 2.) The two 
faces were untouched, but the edges had been beveled and most carefully 
polished. It was discovered in the interior of a skull the entire side of 
which had been cut away, but it was not a part of this skull; the difference 

1 Sur la trepanation dn cr&ue, et les amulettes cr&nienues 5. l’£poqne neolithique, par Paul Broca. 
Paris, 1877, 8°. Also, Eev. d’anthrop., Paris, 1877, vi, 1-42; 193-225. Also, Congrfcs d’anthrop. et 
d’archeol. prdhist., Budapest, 1876, 101-192. 

2 Assoc, franfaise pour l’avancemcnt des sciences. Cornpte rendu do la 2 me sess., Lyon, 1873, Paris, 
1874. 8°, p. 703. 


5 





6 


PREHISTORIC TREPHINING. 


in color, thickness, and density of structure showing, beyond a doubt, that 
it had formed part of another cranium. 

At various times similar pieces of bone were discovered, in some of 
which holes had been drilled or grooves cut, as if for the purpose of sus¬ 
pending the fragments from the person. The name of “rondelles” has 
generally been applied to these fragments, although some archaeologists, 
accepting the theory of M. Pruni&res, have termed them amulets. (Plate I, 
figs. 3, 4, and 5.) 

The use of amulets, as is well known, comes down from the very ear¬ 
liest period, and M. Prunieres was of opinion that the extreme care bestowed 
in polishing these fragments, together with the fact that no other purpose 
could be divined for them, was sufficient evidence as to the use for which 
they were intended. The latter reason, it must be admitted, is not strikingly 
convincing. 

As early as 1868, M. Prunieres discovered, in a large dolmen near 
Aiguikres, a skull of which a large part of the side had been removed. 
This operation had evidently been effected by a cutting or sawing process, 
although one portion of the edge appeared smooth and polished. Many 
“rondelles” were discovered in the same spot, and M. Pruni&res formed the 
theory that they were pieces removed in converting a skull into a drinking 
cup. To drink from the skull of a dead enemy was a refined enjoyment 
not exclusively practiced in the Walhalla of the Norsemen. Livy tells us 
that the Gauls celebrated their victories in that manner, 3 and M. Prunikres 
supposed that the skull and fragments which he had unearthed were relics 
of a similar custom. He made known his views to the Paris Society of 
Anthropology in 1874, 4 accompanying his communication with specimens 
of perforated skulls and rondelles. 

These pieces were examined by Professor Broca, who at once observed 
that the smooth or polished condition of parts of the edges of the rondelles 

3 A cup made from a human skull was exhumed by Mr. E. R. Quick, in 1880, from an aboriginal 
cemetery near Brookville, Franklin County, Indiana. From its size, and from the distinctness of the 
sutures, it was evidently the skull of a young person. The base had been removed, and both the inside 
and outside had been scraped, as the scratches on the bone indicated. Two small holes had been drilled 
at one spot near the edge, evidently for the insertion of tendons or strings to check an incipient crack, 
just as the modern housewife saves a bowl or teacup. Journal Cincinnati Soc. Nat. Hist., ISSO-’Sl, iii, 
5196. Plate of same in vol. iv, p. 257. 

* Bull. Soc. d’anthrop. de Paris, 1874, 2 mc sic., ix, 185-205. 
























































































































































U. S. G. AND G. SURVEY. 


PREHISTORIC TREPHINING , PI. II. 



Cranium from the cavern of L’Homme-Mort (La Lozere). 
tal suture. Two-thirds natural size. (Prunidres.) 


Surgical trephining has been performed upon the sagit- 











FI.KTCII1SU.1 


BROCA’S CONCLUSIONS—ON WHAT BASED 


7 


and of the sections of the skull was due, not to artificial polishing, but to 
a process of natural cicatrization, which must necessarily have taken place 
during life, and, indeed, many years before death. (Plate II.) 

After examination of a great many other specimens, Broca finally 
announced two conclusions as the result of his investigations: 

I. In the neolithic age, a surgical operation was sometimes performed 
for the cure of certain internal maladies, which consisted in making an open¬ 
ing in the skull. This was almost, if not quite, exclusively practiced on 
young children, and is to be termed prehistoric surgical trephining. 

II. The skulls of those who survived this operation were supposed to 
possess some remarkable qualities, and when the owners died, amulets or 
rondelles, consisting of portions of the skull, were carefully cut out. By 
preference, the portion should contain a segment of the original aperture. 
This was posthumous trephining . 5 

A concise account must be given of the evidence upon which these 
conclusions were based. 

To the practiced eye there is no difficulty whatever in distinguishing 
between a section of bone which has not been followed by any reparative 
process and one in which that process has gone on to completion. In 
the first case, the edges are sharp, the cells of the diploe are open, and the 
action of the cutting instrument is seen in the successive cuts by which the 
operation has been performed. It is not uncommon to find scratches on the 
surface of the bone, indicating where the tool had slipped away from the 
intended incision. (Plate I, fig. 3.) 

When cicatrization of a trephined or fractured skull has been perfected, 
the edges present a rounded, ivory-like surface, due to the new osseous tissue 
deposited in the cells of the diploe and upon the edges of the outer and 
inner tables. 

But while it is easy to discriminate between a post-mortem incision and 
one long since healed, it would be very difficult to decide that the incision 
might not have been made during life, but shortly before death. The pro¬ 
cess of repair in bone is much slower than in softer tissues, and it has been 
suggested that the cases of so-called posthumous trephining were really 


5 Sur la trepanation du crane, etc., p. 9. 



8 


PREHISTORIC TREPHINING. 


cases in which the operation had resulted fatally in a very short time, and 
before any process of repair had commenced. To this it may be replied 
that no examples have hitherto been found of skulls or rondelles where the 
section was in process of cicatrization; all are either entirely fresh, or long 
since healed. 6 It would be unreasonable to suppose that these operations 
were entirely successful or else immediately fatal! The operation, in itself, 
is not very dangerous to life, as has been shown by many experiments on 
animals. Its mortality as a surgical measure, in cases of fracture of the 
skull, is due to the serious injury to the brain for which it becomes neces¬ 
sary to employ it. 

A more convincing reply is that, in the greater number of the trephined 
skulls in question, the two sections coexist; a portion exhibiting the rounded, 
ivory surface of ancient cicatrization, the rest of the section being absolutely 
fresh. (See Plates I, V, and VI.) 

The suggestion that these apertures were the result of blows from 
weapons must be at once dismissed. No weapon of that day, or this, could 
produce such openings with their well-defined, beveled edges. The blows 
of stone hammers or axes resulted generally in necrosis, or death of the 
bone, and often in disruption or bulging of the inner table of the skull for 
some distance from the seat of injury. Some excellent examples of the 
consequences of such formidable injuries are to be seen in an article by Dr. 
F. W. Langdon, describing the crania in a prehistoric cemetery at Madison- 
ville, Ohio. 7 The accompanying plate (Plate III), copied by Dr. Langdon’s 
permission, well illustrates the striking difference between the results of 
blows followed by necrosis of the bone, and the condition succeeding the 
operation of trephining. 

The apertures made by the so-called surgical trephining do not differ 
greatly in size; they are nearly always elliptical, seldom round, and extend 
from 35 to 50 millimeters in length, by 6 to 10 millimeters in breadth. The 
edges are very oblique, at the expense of the outer table of the skull. The 
operation appears to have been performed upon all parts of the head, 

6 Some more recent discoveries, however, -which will be referred to later, show that this assertion 
of Broca’s was rather too sweeping. 

7 The Madison ville prehistoric cemetery; anthropological notes. By F. W. Langdon, M. D. Jour¬ 
nal of the Cincinnati Soc. Nat. Hist., iv, Oct., 1881, 250-253. 



U. S. G. AND G. SURVEY 


PREHISTORIC TREPHINING . PI. III. 



Fig. 1. 



Fig. 2. 


Fig. 1. Perforating fracture of the left parietal near its posterior superior angle; internal view showing the de¬ 
pressed fragment of the internal table which has reunited. Fig. 2. Result of injury to right frontal arid parietal 
region, causing extensive sinuses between the inner and outer table. Natural size, (Langdon.) 


































































FLETCHER. | 


ABNORMAL CRANIAL APERTURES. 


9 


excepting the forehead, but in the greater number of instances one of the 
parietal bones has been the chosen site. There is a very interesting skull 
in the Musde Broca [crane de Vaur^al (Oise)], which, in addition to a large 
depression in the frontal bone, presents a remarkable instance of trephining 
on the occipital, two-thirds of that bone having disappeared. Part of this 
opening is due to the surgical operation, the elliptical edges, about half of 
the original aperture, exhibiting the characteristic ivory-like surface of cica¬ 
trization, while the remainder has been removed by post-mortem trephining. 8 

In no instance has an artificial opening been observed excepting where 
the bone was covered by the hairy scalp, and that the purpose was to avoid 
noticeable disfigurement seems a justifiable conclusion. It is also another 
argument against possible origin from wounds in battle, as in such cases 
the forehead was the part most liable to be injured. 

Broca states that the operation must have been performed just as fre¬ 
quently on the female as on the male. 

It is necessary to inquire what other causes may account for abnormal 
cranial apertures. 

I. There are congenital deficiencies. These are generally found in 
the parietal bones, and are nearly always symmetrical, being found in both 
bones. A single congenital aperture has been sometimes observed through 
which hernia of the brain and meninges has taken place. In such cases 
the edges are everted and show a more or less diseased condition. 

II. Disease of the bone may produce openings which may afterwards 
become cicatrized, and thus resemble the apertures in question; but disease 
of the bone always extends beyond the limits of the perforation produced, 
and leaves indelible traces. A close examination of these trephined neolithic 
skulls shows a perfectly sound condition of the bone in the vicinity of the 
aperture in all cases. 9 

III. Traumatic sources have been already discussed and dismissed. 
Even the cavalry saber of to-day could not produce such results. It does 

8 Lesions osseuses de l’homme pr61iistorique en France ct en Alg€rie, par Jules Le Baron. Paris. 
1831, 4° (these), p. 47. 

9 In this Broca was mistaken. A very remarkable instance of trephining in connection with 
disease of the hones of the cranium was communicated to the Soci6t<5 d’authropologie by M. Parrot, in 
1881. A description of the relic will be found farther on. 



10 


PREHISTORIC TREPHINING. 


occasionally cut off a slice of the cranium, but it certainly could not cut 
out rondelles from the parietal bones. (See Plate IV.) 

Contused wounds, such as would be produced by rude weapons, pro¬ 
duce necrosis or death of the bone, and where healing takes place irregular 
apertures remain, entirely unlike the result of a surgical operation. 

The reparative process in wounds of the cranium in the adult is one 
of extreme slowness. An osteitis, or inflammation of the bone, is set up, 
which extends to some distance from the edges of the wound. The vascular 
canaliculi of the two tables become dilated, and it is often years before 
they recover their normal caliber. But in the skulls under discussion, in 
all instances, the edges of the aperture made by surgical trephining exhibit 
the most perfect readjustment of the parts. This is the case in young as 
well as in old crania; in one instance particularly, that of a woman of less 
than twenty-five years of age, the wisdom teeth being still in process of 
development, the traces of the traumatic inflammation have as completely 
disappeared as in the skulls of very old persons. This led Broca to believe 
that the operation must have been performed at a very early age, and other 
observations tend to confirm that theory. Although the operation of tre¬ 
phining, as before stated, is not a very dangerous one when uncomplicated 
by injury to the brain, yet it would be unreasonable to suppose that it was 
never fatal. If sometimes fatal, we should expect to find skulls exhibiting 
the evidence of partial recuperative process. But, with one exception, no 
such relics have been discovered; the edges of the openings are either 
absolutely fresh, indicating post-mortem work, or absolutely cicatrized, 
indicating that the operation had been performed many years before the 
death of the subject. What then became of the failures? 

If the operation was performed only on young children, then the rapid 
decay of their tender bones would answer the question. In dolmens con¬ 
taining a large number of adult crania, it is usual to find nothing but mere 
debris of the bones of children, and in the case of trephined skulls, the thin 
edges of the apertures would offer favorable points for the chemical and 
physical agency of erosion. 

It is unnecessary to relate all the observations and arguments which led 
Broca to the conclusion that prehistoric trephining was performed mainly, 


U. S. G. AND G. SURVEY. 


PREHISTORIC TREPHINING , PI. IV. 



Loss of substance from the vertex of a skull produced by the stroke of a Tartar saber. Natural size. (Mus6e Broca.) 




























































































































































































































. 








































































































U. S. G. AND G. SURVEY. 


PREHISTORIC TREPHINING , PL V. 



Cranium from Cibournios. A-B, median lino ; E, left external orbital apophysis; F, right external orbital apophysis, 
broken, a-6, the cicatrized edge of surgical trephining; a-c, b-d, post-mortem sections. The sagittal suture, instead of 
following the line C-D, has been driven over to the left. Two-thirds natural size. (Broca.) 




























FLETCHER. 


DIFFERENT METHODS OF TREPHINING. 


11 


if not entirely, upon the young child, but one especially striking and 
ingenious illustration which he founded upon a cranium discovered by 
Pruni&res in the dolmen of Cibournios must be related. 

It is well known that the sutures of the skull tend to become firmly 
united with the advance of years. In the young child the remains of the 
sutural membrane still exist, and a separation is easy. In the accompany¬ 
ing drawing it will be perceived that the left parietal bone has been operated 
upon, and the resistance of the arch on that side being thereby diminished, 
the right parietal has encroached considerably over the median line, in the 
process of after growth, indicating the youth of the subject at the time of 
the operation. (Plate V.) 

As regards the general harmlessness of the operation, there is a view 
which must be suggested, in passing, which has not been considered before 
in this connection, and that is the relation of race to traumatism. In other 
words, the capacity to bear wounds or surgical operations, or the contrary, 
dependent not on individual but on race characteristics. Long ago, Velpeau 
said that French flesh and English flesh were quite different, and opera¬ 
tions that were generally successful in the one were frequently fatal in 
the other. The subject is of immense extent, requiring copious observa¬ 
tions, which should include toleration of child-bearing, before any conclu¬ 
sions can be reached. It will be seen presently that the Arab tribes who 
practice trephining regard it as almost without danger. It is possible that 
race is to be regarded as a factor in the calculation of the results of tre¬ 
phining. 

Some account must now be given of the probable manner of proceed¬ 
ing in prehistoric trephining. 

There are three processes by which an opening in the cranium can be 
methodically produced—by rotatory movement, by cutting, and by scraping. 

The most perfect example of the first-named method is in the use of 
the modern trephine, which consists of a steel cylinder with saw-teeth and 
a central pin to guide its first motion; the whole being worked by a cross¬ 
handle like that of a gimlet. This instrument cuts out a circular piece of 
bone, leaving a corresponding aperture with perpendicular edges. The first 
form of the trephine dates back to the early days of Greek surgery; cer- 


12 


PREHISTORIC TREPHINING. 


tainly to more than 500 years before the Christian era. While, of course, 
no instrument of this kind could have been known in the neolithic age, yet 
an opening by terebration could have been obtained with any pointed tool. 
M. Prunikres says that the shepherds of La Loz&re practice it to this day, to 
relieve sheep of the “staggers.” The head of the animal is held between the 
knees of the operator who fixes the point of his large sheath-knife in the 
skull, and by rotation of the handle between his hands a hole is speedily pro¬ 
duced. A similar practice prevails in Germany, according to Vecken- 
stedt, the operation being performed by the shepherds in order to “burst 
a bladder in the inside of the head of the sheep.” But all such openings 
are necessarily round, with nearly perpendicular edges, while the surgical 
trephining of prehistoric times is characterized by elliptical openings and 
by obliquely beveled edges. 

As regards the second method, by cutting, no doubt flint saws might 
have been employed for the purpose, but it would have been impossible to 
produce the even ellipsis, with its broad bevel, in such a manner. A polyg¬ 
onal-shaped aperture could only have resulted. 

There remains the process by scraping. In some of the South Sea 
Islands trephining is practiced in this manner, and, indeed, the exfoliative 
trepan of modern surgery provides for a similar process. Broca presented 
to the Society of Anthropology of Paris, in 1876, gome skulls upon which 
he had himself produced precise counterparts of neolithic trephining by 
scraping with a piece of broken glass. 10 The apertures were elliptical, the 
long axis being in the direction of the to-and fro motion of the scraper, and 
the edges were broadly beyeled. It might seem, at first, that this must 
have been a very slow and barbarous operation, but when it is remembered 
that the evidence points strongly to the belief that trephining was practiced 
upon the very young, the objection, to a great extent, disappears. It took 
Broca nearly an hour to produce the opening in a hard adult cranium, but 
in a child’s skull it required but four minutes to attain the same result. 
Again, in July, 1877, Broca presented to the same society the skull of a 
two months’ old puppy, upon which he had performed the operation of tre¬ 
phining with a piece of flint from Cro Magnon, and, although the flint was 


10 Bull. Soc. cVaiitlirop. do Paris, 1S76, 2 me s6r., xi, 512. 






































































































































. 




























































































































. 










* 








































































U. S. G. AND G. SURVEY. 


PREHISTORIC TREPHINING , PI. I I. 



Cranium from Cibournios. A-B cicatrized edge from surgical.trephining. B-C, A-D, post-mortuu sections. 

Two-thirds natural size. (Broca.) 







FLETCHER.] 


CRANIAL AMULETS OR RONDELLES. 


13 


very blunt and the bone twice as thick as that of a child of six years of age, 
the operation was completed in eight minutes; the dog recovered rapidly 
without any symptom of fever. 11 

It is a curious fact that the amulets or rondelles, in the great majority 
of instances, have been cut from skulls which had undergone, and a long 
time survived, surgical trephining. Many of these skulls exhibit immense 
openings, unmistakably of post-mortem workmanship, but with a fragment* 
of the original cicatrized edge of the surgical operation remaining. (See 
Plates V and VI.) 

Many crania have been discovered with the characteristic opening indi¬ 
cating surgical trephining long since cicatrized, but which had been sub¬ 
jected to no post-mortem operation. Why these exceptions should occur it 
is impossible to discover. Possibly they were due to the law of demand 
and supply, and the amulets not being wanted at the time, the skulls were 
left undefaced. 

Quite a large number of these so-called amulets or rondelles have been 
discovered, and are to be seen in the museums of Europe. 12 Some of them 
are very regular in outline, and very considerable labor has been bestowed 
upon them to produce a polished surface and rounded edges. The rondelle 
discovered by Professor Prunikres in the interior of a skull, and which first 
drew attention to the subject, is highly polished and beveled at the expense 
of the outer table. (Plate I, fig. 1.) These carefully prepared amulets have 
a very different appearance from the fragments of cranial bone which are 
found in ancient burial places. The latter are more or less discolored and 
eroded by the moisture and mineral ingredients of the soil in which they 
have rested. The rondelles, on the other hand, have a dry, hard surface, 
and are almost of the color of old ivory. This is probably due to their 
having been worn as ornaments or amulets for a very long time; perhaps 
by many successive owners. Other amulets are of irregular shape, being 
elliptical, trapezoid, or triangular. Some amulets have been found with a 

11 Bull. Soc. d’anthrop. de Paris, 1877, 2me s6t., xii, 400; 477. 

12 Prunices. Sur les cranes performs et les rondelles cr&niennes de l’6poque n6olitkiquc. Assoc, 
franfaise pour l’avancement des sciences. Compte rendu, 3 rae sess., Lille (1874), Paris, 1875, 597-637. 

-. La cremation dans les dolmens de La Lozfere. Nouvelles rondelles cr&niennes. Dolmens de 

la Marcoui&re et tombelle de Bonjoussac. Ibid., 6 m0 sees., Le Havre (1877), Paris, 1878, 675. 



14 


PREHISTORIC TREPBINING. 


groove cut around them, apparently for the purpose of suspending them from 
the neck. (Plate I, Fig. 5.) 

It now remains to give some account of Broca’s theory as to the pur¬ 
pose of this surgical and post-mortem trephining. He rejected the theory 
that the surgical operation in early life was performed on account of fracture 
or disease of the bone, nothing whatever in the relics seeming to indicate 
such conditions. He was, at one time, disposed to think that the operation 
had a religious or superstitious motive, and that it indicated initiation into 
some sacred order; but the extent of the discoveries of trephined skulls, 
and the fact that women as well as men were subjected to the operation, 
obliged him to give up that view. His conclusion was that, in all probability, 
the operation was performed as a cure for convulsions, simple or epileptic. 

Trephining as a curative, treatment for epilepsy has been practiced some¬ 
what extensively in our own day, but it is now entirely abandoned, except 
in cases of traumatic epilepsy, when the manifestation of the disorder has 
been coincident with an injury to the skull. In such cases, removal of de¬ 
pressed fragments of bone is clearly indicated, and has, in many instances, 
been followed by entire disappearance of the epileptic fits. 

In the curious storehouse of absurdities which our ancient Materia 
Medica exhibits, powdered bone from the human skull, as well as powdered 
mummy, figure as unfailing remedies for epilepsy. Sometimes the bone 
was to be calcined, and the supplementary ossicles of the skull, known as 
ossa Wormiana, were in high repute for this purpose. In old works the 
title of os antiepilecticum was an ordinary name for a Wormian bone. 

For many ages epileptics were believed to be possessed of devils and 
to be fit subjects for exorcism. When, in obedience to spell or potent com¬ 
mand, the evil spirit left the sufferer, or, in other words, when the fit was 
over, it was through the open mouth that the exit was made. There is a 
cut in a curious old German block-book representing the well-known inci¬ 
dent of the epileptic of the New Testament. The mouth of the man is 
painfully distended, and the horned head of a small imp is visible emerging 
from his throat. The herd of swine, unconscious of the impending catas¬ 
trophe, are watching the proceeding. It is not difficult to imagine how 
appropriate it would appear to make an opening in the skull for the escape 


FLETCHER.] 


BELIEF IN FUTURE EXISTENCE INFERRED. 


15 


of an evil spirit which could not be dislodged by ordinary exorcism . 13 It is 
for this purpose, among others, that trephining is practiced to this day among 
the South Sea Islanders and by some of the Arab tribes of Algeria. 

From these and similar considerations Broca was led to believe that 
prehistoric trephining was practiced for the relief of convulsions in infancy 
or childhood, and that a fragment of the skull of a person who had under¬ 
gone this operation was worn as a preventive of the like common and 
alarming disorder. Hence the care with which a portion, at least, of the 
cicatrized border was preserved in the piece cut out to form the amulet. 

It must be borne in mind that a primitive people would not be likely 
to discern any difference, except of degree, between the ordinary convul¬ 
sions of childhood and epileptic fits. The former, though alarming in 
appearance, are by no means generally dangerous, and we can easily under¬ 
stand that the surgical operation would, in such cases, be credited with the 
cure. It is thought, even in our own enlightened day, that the post quod 
is occasionally taken for the propter quod , in surgical as well as medical 
therapeutics. 

So far, it may be said that Broca made a fair case in favor of his theory, 
but he carried his theorizing still further. He was of opinion that these tre • 
phined skulls and corresponding amulets indicated that a belief in a future 
existence obtained among these primitive races. His argument is based 
upon the discovery of amulets in the interior of trephined crania. “ Why,” 
he asks, “was this precious relic placed inside the skull at burial? Was it 
not a talisman to preserve the defunct, in a future existence, against the 
evil spirits that had afflicted him in early life? If so, does it not show that 
a future existence was anticipated?” 

When it is remembered that only three cases have been observed in 

13 A curious custom is related by Miss A. W. Bucklaud, which may possibly be due to some legend- 
ai'y trace of the belief in the efficacy of trephining as a remedy for fits. She observed at Cannes, in 
the south of France, a number of dogs with oblong patches of red leather stuck on their heads, and 
upon inquiry was informed that these dogs were subject to fits, and that the red leather was worn as a 
means of prevention. Jour. Anthrop. Inst. London, 1881, xi, 16. 

This part of the subject must not be dismissed without an allusion to the story of the birth of 
Athene, so inimitably told by Lucian. It will be remembered that Zeus, suffering from intolerable pain 
in the head, called upon Hephaestus to split open his head with an axe. The latter unwillingly obeyed, 
when from the fractured opening sprang out the Goddess of Wisdom, clad in bright armor and with 
spear in hand. This is probably the first recorded instance of historic trephining. 





16 


PREHISTORIC TREPHINING. 


which rondelles were discovered in the interior of skulls, it must be ad¬ 
mitted that this amiable theory rests upon a very slender foundation. It 
seems much more probable that their presence in the locality in which they 
were found was due to accidental causes, such as the pressure of roots, or 
the movements of worms. Mortillet and Prunikres both mention finding 
small bones of the hand or foot inside of crania. 

As regards the extent and range of the relics indicating this singular 
custom, it may be said that, in France, the department of La Lozkre has 
produced the greatest number. This, however, is probably due to the vig¬ 
orous researches of Pruni&res and others in that region. Throughout the 
south and southeast of France discoveries of trephined skulls continue to 
be made. Broca states that the custom certainly prevailed throughout the 
entire neolithic or polished stone period, as trephined skulls have been 
found in the cavern of L’Homme-Mort, in La Lozkre, which belongs to the 
earliest part of that age, and in the grottoes of Baye, belonging to its close. 
While it is not surprising that no trace of the custom should have been 
discovered in the relics of the palaeolithic or mesolithic ages, it is certainly 
remarkable that it should have disappeared with the neolithic age so com¬ 
pletely. It is perhaps not too much to say that no authentic instance of the 
discovery of a trephined skull from the bronze period is on record Doubt¬ 
less the rapidly increasing custom of incineration of bodies must be regarded 
as a principal cause. M. de Baye has found cranial amulets in tombs of a 
later epoch, and infers that the custom of trephining still prevailed. 14 This 
does not, however, follow, as the amulets may have been preserved through 
many generations. 

At the meeting of the International Congress of Prehistoric Anthro¬ 
pology held at Brussels, in 1872, Dr. Gr. A. Lagneau read a paper entitled, 
“ Sur les cranes de Furfooz”; and in the discussion which followed the meas¬ 
urements of some Esthonian crania were given by M. Quatrefages. In the 
plate 15 illustrating the latter, one skull has an aperture about the center 
of the coronal suture which strikingly resembles the beveled edges pro- 

14 Bull. Soc. d’autlirop. de Paris, 1876, 2 me s6r., xi, 121. 

16 Congr&s international d’antliropologie efc d’arch&dogie prdhistoriques. Compte rendu, 6 me ses¬ 
sion, tenue h Bruxelles en 1872, Bruxelles, 1873, 558. 



FLKTCHEH.] 


SPECIMENS DISCOVERED IN FRANCE. 


17 


duced by trephining. No allusion was made to it, the subject at that time 
not having been brought to light. 

As early as 1875 a trephined skull was found in a tumulus at Bougon, 
near Niort, in the south of France, which was described by M. Babert de 
Juilld In his specimen, the openings had been made near the top of the 
skull, and the edges were perfectly cicatrized. 16 

At the meeting of the Association for the Advancement of Science held 
at Nantes, M. Chauvet. presented a cranial amulet found in a tumulus in the 
forest of Boixe. 17 

In thetertre Guerin, on the right bank of the Seine, not far from Paris, 
M. Chouquet found the skull of an old man, with a trephined aperture which 
had been long completely cicatrized. 18 M. Chouquet also discovered some 
specimens of both surgical and posthumous trephining in a mound, near 
Ecuelles, which contained incinerated bones. He was disposed to think 
that these relics belonged to the bronze age. 19 

In 1877 M. Pruni&res presented to the Paris society two admirable 
specimens, in one of which the aperture, thoroughly cicatrized, was in the 
occipital bone, a little to the right of the median line—an unusual position. 20 

M. Gassies discovered a trephined skull at Entre Roche, near Bordeaux, 
in a burial-place which he thought to be palaeolithic. Further researches, 
however, by M. Chauvet, assigned it to the neolithic period, a polished stone 
axe and similar relics having been discovered there. 21 Some other doubtful 
cases of trephined skulls from the palaeolithic period have been announced, 
but no well-authenticated specimens have been discovered which are of 
earlier date than the polished stone age. 

An interesting specimen was presented to the Paris society, in 1878, 
by M. Gudgan. 22 It was found in a dolmen at Ftang-la-Ville, and exhibited 

16 Rapport de la commission des tumuli de Bougon, suivi d’une etude sur la trepanation prehisto- 
rique, ot en particulier sur le cr&ne tr6pan<5 que possede la mus^e de Niort. Par Babert de Juilld. Niort, 
1875. 8°. 

17 Assoc. fran§aise pour l’avancement des sciences. Compte rendu de la 4 me sess., Nantes, 1875, 
Paris, 1876, 854. 

18 Bull. Soc. d’anthrop. de Paris, 1877, 2 me sdr., xii, 13-16. 

1 Ubid ., 1876, 2 rae s6r., xi, 279. 

20 Ibid., 551. 

21 Ibid., 1877, 2 me sdr., xii, 12. 

*>lbid., 1878, 3 m0 s6r., i, 198. 

2 P T 



18 


PKEIIISTOBIC TBEPniNING. 


incomplete trephining by raclage , or scraping. This modification of the 
process of trephining consisted in removing the outer table of the skull by 
scraping, leaving the inner or vitreous table intact. Altogether some twenty 
specimens of the kind have been collected. What the object was of this 
incomplete operation it is difficult to divine. Possibly the malady was 
relieved and the further process rendered unnecessary. 

In 1603 there was published in Lyons a book which is now excessively 
rare. Its title was: Traicte de l’epilepsie, maladie vulgairement appelee au 
pays de Provence, la goutette aux petits enfants. Par Jehan Taxil. 8°. 
The writer evidently confounded convulsions with epilepsy, the latter disease 
not attacking little children, rarely, indeed, developing itself before the tenth 
year. The remedy he prescribes is scraping away a portion of the outer 
table of the skull. Sometimes the inner table, also, was removed by the 
exfoliative trepan. This reproduction of a prehistoric usage may perhaps 
be cited as a curious instance of atavism in surgery. 

In 1878 M. Prunikres made some extensive researches in the caverns 
of Beaumes-Chaudes (La Lozere), and found more than sixty specimens of 
trephined skulls and cranial amulets. In three of these there was evidence 
of the operation having been twice performed on the same subject. 23 

In 1880 M. Mauvoisin found in some artificial grottoes near. Baye sev¬ 
eral crania of the neolithic age, of which two exhibited cicatrized openings. 
Upon one of them post-mortem sections had been made in the usual manner. 24 

A recent and very interesting contribution to our knowledge of the 
subject is to be found in a paper read before the Paris Society of Anthro¬ 
pology by M. Parrot. 25 It describes a cranium found in a grotto of the neo¬ 
lithic period at Bray-sur-Seine (Marne). The frontal and both parietal 
bones exhibit the consequences of extensive disease. Depressions exist, such 
as would be produced, M. Parrot says, by pressing the thumb into soft 
putty. On the left parietal a small island of undiseased bone stands up in 
the center of the depressed portion, forming a strong contrast. The borie 

23 Bull. Soc. d’anthrop. do Paris, 1878, 3 me sdr., i, 211. 

1880, 3 me s6i\, iii, 10. 

2S Crano trouv6 dans uue grotte de l’dpoque de la jiierre polie h Bray-sur-Stine (Marne), avec uno 
quarantaine de squelettes, haohes polies, poingons en os, colliers et ornements eu coquilles. Ibid., 1881, 
3 mc s6r., iv, 104-108. 




FMSTCHKR J 


TREPHINING FOR DISEASE OF BONE. 


19 


which has been subjected to disease is excessively thin, and was broken in 
two or three places in the process of extraction No trace was left of the 
coronal suture, the disease having entirely obliterated it. But the most 
interesting feature was the evidence that surgical trephining had been per¬ 
formed, apparently for the relief of the disease. The opening made involved 
the frontal and left parietal bones; it was of the usual oval shape, but its 
size could not be exactly ascertained, as the posterior portion of it was lost 
in a large, irregular hole, produced, no doubt, when the skull was removed 
from the earth. The trephining was performed partly on sound and partly 
on the diseased bone, and the edges of the aperture (what remains of them) 
are perfectly cicatrized, so that it is evident that the patient long survived 
the operation. It cannot be held that the disease was the result of the opera¬ 
tion. In the large number of trephined skulls which have been examined 
there is no instance of disease of the bone, and in this particular case, as 
M. Parrot observes, if the disease had resulted from the operation it would 
have spread all around the opening, which is not the case, as what remains 
of the aperture is in soupd bone. 

The disease, which was probably an exfoliative osteitis or inflammation 
of the bone, was, M. Parrot thinks, of traumatic origin. There is a depres¬ 
sion on the frontal bone w'hich may have been caused by a liatchet-stroke. 
Whether the operation was performed to arrest the disease, or to remove 
some of its symptoms, is, of course, a matter of conjecture; but as the dis¬ 
eased bone and the edges of the aperture had all become firmly cicatrized, 
it is certain that the patient lived for some years after. 

M. Parrot dwells upon the importance of this discovery as proving that 
trephining was employed as a therapeutic measure in disease, and not only 
for the relief of imaginary causes of evil, as in convulsions or epilepsy. 
It is possible, however, that the subjective symptoms attending such exten¬ 
sive disease of the cranium may have required the usual remedy for eviction 
of the supposed malignant spirit. 

In Germany a few examples have been met with of prehistoric trephin¬ 
ing. Prof. H. Wankel discovered in the grotto of Bytchiskala, in Bohemia, 
the skeleton of a girl of about twelve years of age. The skull bore unmis¬ 
takable evidence of surgical trephining having been performed during life. 


20 


PREHISTORIC TREPHINING. 


The aperture was on the right side of the frontal bone, was nearly circular 
in shape, and about 3 centimeters in diameter. The inner table of the skull 
exhibited no trace whatever of inflammatory process, such as would inevi¬ 
tably have accompanied caries or exostosis of the bone. At great length 
Professor Wankel examines every possible disease or injury of the bone 
which might be supposed to account for the opening, and rejects them all. 
From this argument by exclusion he arrives at a very firm belief that the 
case was one of surgical trephining, precisely analogous to those observed 
in the crania of La Lozkre. 26 

About the same time Dr. B. Dudik sent a communication to the Berlin 
Ethnological Society, announcing his discovery of many trephined skulls 
in the ossuarium, or Beinhaus, at Sedlec in Bohemia. 27 In this famous bone- 
heap there are pyramids of skulls and thousands of human bones. Tradi¬ 
tion states that they came from the old churchyard of Sedlec, the soil of 
which, having been made sacred by admixture with earth brought from Geth- 
semane, had the property of rapidly decaying the flesh and of preserving the 
bones with a whiteness as of alabaster. The structure which now incloses 
the relics was erected in 1709, but allusions to the Sedlec bones are to be 
found in very early chronicles. A local legend relates that the perforated 
skulls (of which there are a great many) once belonged to the Cistercian and 
Carthusian monks who were killed when-the Hussites, under Ziska, captured 
the convent of Sedlec in 1421. Dr. Dudik thinks that the punctures are 
too even and too free from fracture to have been made by the spiked clubs 
with which Ziska’s followers were armed. This objection is probably not 
well-founded. The writer remembers examining a heap of skulls of horses 
in a knacker’s yard, the animals having bedh destroyed with a pole-axe, a 
weapon very similar to a spiked club, and the punctures were, in almost all 
instances, round with sharp edges and not accompanied by fracture. It 
seems probable that these bones have accumulated through a very long 
period of time, but that they date principally from the year 1318, when 
a pestilence ravaged Bohemia and thirty thousand persons were buried in 
Sedlec alone. 

26 Wankel (H.). Ein priihistorischer Scbiidel mit. einer balbgebeilten Wnnde auf derStirne hoclist- 
wabrscbeinlicb dnrcli Trepanation entstandeu. Mittk. d. anthrop. Gesellscb. in Wien, 1878, vii, 86-95. 

27 Dudik (B.). IJeber trepanirto Cranien im Beinbanse zn Sedlec. Ztsclir. f. Ethn., Berl., 1878, x, 
227-235. 



FI,ETCI1E11. ] 


THE SEDLEC BE IN LI A US. 


21 


Dr. Dudik describes at some length the appearance, of the openings in 
the crania which he Examined, but it would seem from his description that, 
in most instances, posthumous trephining alone had been practiced. This, 
of course, proves nothing. In a few cases he describes what seems like 
cicatrization of the edges 

A more competent observer, however, followed in his footsteps. Pro¬ 
fessor Wankel visited Sedlec in order to verify the observations of Dr. Dudik, 
and examined the one hundred and twenty crania which had been submitted 
to the latter. 28 Wankel was of opinion that, in every instance, the perfora¬ 
tions were the result of wounds not immediately fatal. In two instances he 
agreed with Dr. Dudik that there were unmistakable marks of posthumous 
trephining. Professor Wankel finishes his article by a description of his visit 
to Prague, in the museum of which city he found two skulls from Bilin, in 
Bohemia, exhibiting evidence of prehistoric trephining. One, a dolico- 
cephalic skull, presented an orifice 60 millimeters by 40, of elliptic shape, 
and situated in the center of the right parietal bone. The edges were 
perfectly cicatrized, and exhibited the ivory-like surface characteristic of 
long-healed trephining. In the other, a mesocephalic skull, the aperture 
was round and about 40 millimeters in diameter. Professor Wankel was 
of opinion that these skulls exhibited perfect specimens of prehistoric sur¬ 
gical trephining, and goes on to observe that, even to the eye of a layman, 
the difference between the holes in these skulls and those in the crania of 
the Sedlec ossuarium was most marked. 

A notice of these two interesting specimens was sent to the Paris 
society by M. Ingoald Cludset two years before. 29 

Professor Virchow has contributed some observations illustrative of 
the subject. At a meeting of the Berlin Anthropological Society, in 1879, 
he described a skull from a neolithic burial mound, in which the char¬ 
acteristic marks of cicatrization were observed in an opening in the right 
parietal bone. At a later meeting he also reported some discoveries made 
by General von Erckert in a Cujavian grave near Ziemcin, in Poland. 
Among them was a bone disk, or rondelle, bearing a great resemblance to 

28 Wankel (H.). Ueber die angeblick trepanirten Cranien des Beinbausos zu Sedlec in Bobuien. 
Mittk. d. autlirop. Gesellscb. in Wien, 1879, viii, 352-360. 

29 Bull. Soc. d’antbrop. de Paris, 1877, 2 me sdr., xii, 10. 



22 


PREHISTORIC TREPHINING. 


those described by Broca. 30 Dr. L. Schneider presented to the same society 
a similar example from the skulls of Strupcic, Bohemia. 31 

In 1875 an article was published by Dr. R. Wiedersheim, entitled, 
“Ueber den Madelhofener Schadelfund in Unterfranken ” This appeared 
before attention had been drawn to the subject of prehistoric trephining-, 
but in one of the plates is a cranium with an opening in the left parietal 
bone, presenting a remarkably strong resemblance to the accepted form of 
surgical operation. 32 

At a meeting of the Italian Society of Anthropology, held in 1878, Pro¬ 
fessor Mantegazza exhibited a papier-machd model of a Russian skull taken 
from a tumulus at Bogdanoff, which presented an example of surgical tre¬ 
phining undoubtedly performed during life. Posteriorly was a second 
aperture of post-mortem origin. 33 

M. Nicolucci discovered in a tumulus in Italy a rondelle from the 
occipital bone, highly polished on both sides, but no trephined skulls have 
as yet been discovered in that country. 

In Denmark a trephined skull was found in a dolmen at Borreby, and 
another was discovered by M. Engelhardt, in a dolmen of the stone age, at 
Noes, in the island of Falster. 34 

Broca received from General Faidherbe some casts of skulls from 
Roknia, Algeria, one of which proved to be an excellent example of surgi¬ 
cal trephining. Since his death another specimen has been received from 
Roknia, which is deposited in the Musde Broca. In this skull the opening— 
of the usual beveled, elliptical shape, and 13 millimeters in diameter—is 
above the left external orbital apophysis. There is no evidence of repair on 
the edges, so that it would seem that the operation was fatal; but as the 
entire inner table of the skull has disappeared, from erosion, M. Le Baron 
suggests that the cicatrized edges may have met with a similar fate. 35 

So far no discoveries of trephined crania have been made in Great Britain; 

30 Ueber trepanirte Schiidel von Giehichenstein. Verhandl. der Berliner Gesellsch. lur Anthrop., 

Berlin, 1879, 64-67.-. Knocliensclieibe aus einem Schadel, welche an ein trepauirtes Stuck eriu- 

nert. Ibid., 436. 

31 Ueber die Hradiste von Stradonice und die Schadel von Strupcic (Bohmen). Ibid., 239. 

32 Archiv fur Anthrop., Braunschweig, 1875-76, viii, 225-236. (Plate XV, figs. 1 and 2.) 

^Arcliivio per 1’ autropologia, etc., Milano, 1878, viii, 527. 

31 do Nadaillac. Les trepanations pr6historii)ues. Paris, 1879. 8°, p. 7. 

36 Lesions osseuses, etc., 67. 



FLKTCHEU. ] 


CASE OF UNCOMPLETED TREPHINING. 


23 


but it may be mentioned, as illustrating tbe growth of interest in the subject, 
that in France counterfeit rondelles have recently been put upon the market. 

In the splendid prehistoric gallery of the geological section of the 
museum at Lisbon is a cranium quite unique of its kind. 38 It presents evi¬ 
dence of an uncompleted operation of trephining upon the left parietal bone. 
The groove, made by some cutting or sawing instrument, has nearly reached 
the internal table, very clearly defining the rondelle, which measures 6 cen¬ 
timeters by 2, and from the numerous scratches on the surrounding bone it 
is evident that the instrument frequently slipped from the groove in the pro¬ 
cess. Why the piece was not entirely detached it is useless to surmise. M. de 
Mortillet was of opinion that the discovery rather tended to disprove Broca’s 
theory that the operation was performed by scraping until a hole was pro¬ 
duced. It must be observed, however, that there is no evidence to prove 
that the operation was performed during life in the case in question. It is 
more likely that it was an attempted post-mortem trephining; but even 
if it were not, its occurrence would only strengthen the views expressed 
elsewhere in this paper, that though prehistoric trephining was probably 
performed by scraping in the young subject, and that examples of this 
method form the great majority of specimens in our museums, yet that it is 
probable, from analogy, that when performed on the adult it was by saw¬ 
ing, cutting, or by a series of punctures. 

The cranium in question was found in the grotto of Casa da Mouva at 
Peniche, which contains the remains of one hundred and forty persons of 
the neolithic period. 

In America nothing has been discovered that can be said to belong to 
prehistoric trephining, except the famous Inca skull brought by Mr. Squier 
from Peru, and presented by him to the Paris Society of Anthropology. 
This relic, which consists of the face and frontal bone, is stated by Mr. 
Squier to have been taken from an Inca cemetery in the valley of Yucay, 
within one mile of the “ Baths of the InCas.” 37 

156 Notes stir l’arcbdologie prdkistoriquc en Portugal, par Em. Cartailliac. Bull. Soc. d’anthrop. 
do Paris, 1881, 3 me sdr., iv, 281-307.—Trepanation prehistorique, par A. de Mortillet. Ibid., 1882, 3 n, ° 
sdr., v, 143-146. 

37 Peru. Incidents of travel and exploration in tbe laud of the Incas. By E. George Squier. New 
York, 1877. 8°, p. 456; Appendix, p. 577. It is also described in that singularly unique publication, vol. 
i, No. 1 (all ever published), of the Journal of tbe Anthropological Iustitute of Now York for 1871-72. 



24 


PREHISTORIC TREPHINING. 


The drawing (Plate VII) shows how entirely the operation in this case 
differs from the elliptic openings of the French crania. The round white 
spot indicates where the periosteum had been removed by the operator; and 
this was done, Broca thought, about eight or ten days before death. The 
famous surgeon, Nelaton, who also examined the bone, suggested fifteen 
days. 33 As no evidence of fracture was visible, the French experts were of 
opinion that the operation was performed to evacuate fluid in the cavity, 
but Dr. J. P. Nott, of Mobile, offered the very plausible suggestion that a 
punctured wound, such as the known weapons of the Peruvians might 
inflict, might have necessitated the operation. The incisions appear to have 
been performed with a cutting instrument, something like an engraver’s 
burin, and not with a saw. 

In 1875, Mr. Henry Gilman, then of Detroit, published a description 
of ten to fifteen skulls obtained from mounds on Sable River, Lake Huron, 
and two fragments from Great Mound, River Rouge, 
Michigan. 39 All of these skulls presented a circu¬ 
lar perforation at the vertex, “ evidently' made,” 
he says, “ by boring with a rude, probably stone, 
instrument, varying in size, in some instances hav¬ 
ing a diameter of one-third of an inch; in others, 
of one-half’ of an inch, and flaring at the surface” 
(%• 0 - 

At the Detroit meeting of the American Associa- 

FiG. 1.—Artificially perforated # 

skuii from mound at Sable River tion for the Advancement of Science, Mr. Gilman 

(Lake Huron), Michigan; one- 

quarter size. read a more elaborate paper on the same subject, 40 

and, at the twenty-sixth meeting of the society, this was followed by 
another paper, entitled, “Additional facts concerning artificial perforation 
of the cranium in ancient mounds in Michigan.” 41 Mr. Gilman was very 
positive that the perforations were not analogous to the prehistoric trephining 
observed in France. They were merely holes bored after death, and it was 
suggested by Professor Mason that, like the Dyaks of Borneo, the natives 

3K Bull. Soc. d’antlirop. de Paris, 1867, 2 me sdr., ii, 403. 

3U Amer. Naturalist, Salem, 1875, ix, 473. 

•*°Proc. Am. Ass. Adv. Seieuco, 24th meeting, at Detroit, 1875, Salem, 1876, 316-331. 

"Ibid., 26th meeting, at Nashville, 1877, Salem, 1878, 335-339. 






U. S. G. AND Cr. SURVEY. 


PREHISTORIC 'TREPHINING, PR VII. 




% 


















FLETCHER.] 


PERFORATED AMERICAN CRANIA. 


25 


might have made the punctures for the convenience of stringing the skulls. 
This would explain why the hole was invariably at a point opposite to the 
foramen magnum. A discovery of Mr. Gilman’s, however, seems to throw 
some doubt upon this theory. He found, in a mound at Devil River, Mich¬ 
igan, the remains of a person, evidently of rank, lying upon his back, but 
with the characteristic perforation in his skull. 

Mr. W. C. Holbrook, in an account of his examination of some Indian 
mounds on Rock River, at Sterling, Ill., says: 

Inside this dolmen I found the remains of eight human skeletons. . . . One of the skulls pre¬ 
sented a circular opening about the size of a silver dime. This perforation had been made during life, 
for the edges had commenced to cicatrize. 42 

It is not stated in what part of the skull the opening was found, nor 
whether any evidences of fracture or other injury existed, so that, as it 
stands, the case cannot be thought to be one of trephining, but rather one 
of a partly healed wound. 

Before concluding this review of the evidence so far accumulated upon 
the subject, some account must be given of the method of trephining prac¬ 
ticed in our own day by some semi-barbarous tribes, with the purpose of 
seeing whether it throws any light on the prehistoric operation. 

In the djebel Aour&s (Mont Aur&s), the southern termination of the 
Atlas mountain range, in the province of Constantine, in Algeria, there 
exists a race of Kabyles who are the descendants of the Berbers, the gen¬ 
uine autochthones of Africa. The practice of trephining prevails exten¬ 
sively among them, although it is by no means general among other tribes 
of Kabyles. Two French army surgeons, MM. L.-T. Martin 43 and Am^dde 
Paris, 44 have given very full accounts of the method adopted. 

It appears that the operation is performed for fracture of the skull, 
whether simple or compound, for disease of the bone, and for violent pains 
in the head. It may be performed at any age, upon either sex, and upon 
any part of the skull, though the parietal bones seem to be most frequently 

42 Amer. Naturalist, Salem, 1877, xi, 688. 

•“La trepanation du cr&ne, telle qu’elle est pratiqu^e par lea Kabyles de l’Aures. Par L.-T. Mar¬ 
tin. Le Montpellier rndd., 1867, xviii, £25-535. Also, Reprint. 

44 De la trepanation cephalique pratiquee par lea medeciua indigenes de l’Aouress (province do 
Constantine). Par M. le dr. Amedee Paris. Gazette med. de l’Algerie, Alger, 1868, xiii, 25-28. Also, 
Reprint. 



26 


PREHISTORIC TREPHINING. 


chosen. M. Paris did not meet with any instances in which the operation 
had been performed upon subjects of less than tenor more than sixty years 
of age. 

The instruments are rude and simple enough, consisting of a razor, a 
serpette, one or two saws, some straight and curved elevators, and the 
brima , or perforator. This latter is a metal rod, as thick as a ramrod, with 
a point an eighth of an inch long, but not over one-third of the diameter 
of the rod, which thus forms a shoulder and prevents too deep a penetration 
of the instrument. (See Plate VIII.) The point being fixed in the bone, 
after removal of the scalp by a crucial incision, the rod is taken between 
the hands of the operator, and by a rapid to-and-fro motion is made to 
revolve so that a puncture is produced. This is followed by another and 
another, until the fracture or the portion of bone intended to be removed is 
surrounded with a row of these holes, very close together. The saw is used 
to run them one into the other, and by means of the elevator the fragment 
is removed. The dentated edges are smoothed, a shield is fastened over the 
aperture, and appropriate dressings, with many ceremonies, applied. The 
operation is performed with great slowness, and is not generally completed 
at one sitting. It must, one would think, be exquisitely painful, but it is 
held to be a point of honor to exhibit no evidence of suffering, and if 
the patient should be so weak as to utter cries, he is jeered at, and even 
beaten. 

The foregoing description of the method of operating is taken from the 
article by M. Martin. There is a difference in the pro¬ 
cedure as related by M. Paris, who does not mention - 
the use of the brima or of any analogous instrument. 
He says that the tliebibe cuts out a square piece of 
bone, inclusive of the injured portion, with a saw, lift- 
f.g. 2.—Fragment from Kabyie ing the fragment with the elevator. Great violence is 

skull, forcibly broken out in the . , . ,, . i 

operation. sometimes used m tins part ot the operation, and a 

portion of the outer or inner table is occasionally forced off, as in the accom¬ 
panying figure; the bone from which it was drawn was in the possession of 
M. Paris. 





U. S. G. AND G. SURVEY. 


SR ENTS TOR TC TREPHINING, PI. VIII. 



Fig. 1. Mouss (razor). 

Fig. 2. Boussadi (knife). 

Fig. 3. El-Chretaf (hook). 

Fig. 4. Mesella (elevator). 

Half-size. 


Fig. 5. Cliefra (elevator). 

Fig. 6. Brim a (perforator). 

Fig. 7. Menchar (saw). 

Fig. 8. Boussadi converted into saw. 

(Martin.) 


































































































■ 









A 














* 

* 














. -i 




















FLETCHER.] 


KABYLE TREPHINING. 


27 


The thebibe (operator) is a sort of semi-priest who has inherited the 
right to exercise his function; the operation, the instruments, the dressings, 
are all sacred, and the patient is held in reverence after recovery. The 
dressings consist mainly of woman’s milk and of butter; the former obtained 
from a woman who has duly performed her religious rites. Both these 
ingredients figure in ceremonial observances in the Orient. 

It is impossible to draw any conclusion as to the results of this process 
of trephining. The thebibes insist that it is alwa}^s successful, but Arab 
mendacity is proverbial, and neither M. Paris nor M. Martin gives any 
credence to their statements. When commencing the incisions, the thebibe's 
formula is thus pronounced: Thou wilt recover if it please God. If the patient 
succumb, his family are told: It was written. 

The natives, however, certainty regard the operation as without danger 
to life, and it is even resorted to as a means of extortion. M. Paris relates 
that two men having quarreled, one struck the other a blow on the body 
with a stick. Some days after the latter had his head trephined for a pre¬ 
tended fracture and sued his enemy for damages. The deception was 
exposed, and both patient and surgeon were punished. The dieh , or price 
of blood, is rigorously exacted among them, every injury, even a fatal one, 
having its established price. M. Martin mentions that he has seen men upon 
whom trephining had been practiced five or six times, so that their heads 
were monstrously disfigured. It is to be borne in mind that in these cases 
the operation was performed at intervals of time for different injuries. 

A remarkable case has been recently published in which the patient 
was trephined five times within five years. 45 The disease of the bone for 
which these successive operations were performed originated in blows 
received in a brawl in 1875. The last trephining took place in 1880, and, 
so far, appears to have been successful. 

In Otaheite, the operator’s armamentarium consists of pieces of broken 
glass bottles for scraping, or, sometimes, of flints, shark’s teeth for incisions, 
and pieces of gourd with shark tendons for strings with which to cover the 
opening produced. A missionary at Uvea, one of the South Sea Islands, 

45 A case of repeated trephining. By P. B. McCutchon. New Orleans Med. & Surg. Journal, 1881, 
ix, 259-261. 



28 


PltEHISTOlilC TREPHINING. 


gives a very clear and interesting account of the method of trephining prac¬ 
ticed at that spot . 40 He says: 

A very surprising operation is performed on the island of Uvea, in the Loyalty group.. A nolion 
prevails that headache, neuralgia, vertigo, and other cerebral affections proceed from a crack in the 
head or pressure of the skull on the brain. The remedy is to lay open the scalp with a cross or X 
incision, then scrape the cranium carefully and gently with a piece of glass until a hole is made iuto 
the skull, down to the dura mater, about the size of a crown piece. Sometimes this scraping operation 
will he even to the pia mater by an unskillful surgeon, or from the impatience of the friends, and death 
is the consequence. In the best of hands about half of those w r ho undergo the operation die from it. 
Yet this barbarous custom, from superstition and fashion, has been so prevalent that very few of the 
male adults are without this hole in the cranium, or “have a shingle loose,” to use an Australian phrase. 
I am informed that sometimes an attempt is made to cover the membranes of the cranium so exposed by 
placing a piece of cocoanut shell under the scalp. For this pnrposo they select a very hard and durable 
piece of shell, from which they scrape the softer parts and grind quite smooth, aud put this as a plate 
between the scalp and skull. Formerly the trephine was simply a shark’s tooth; now a piece of broken 
glass is found more suitable or less objectionable (if we may even so qualify the act). The part of the 
cranium generally selected is that where the coronal and sagittal sutures unite, or a little above it, upon 
the supposition that there the fracture exists. 

The semi-religious character of all and everything concerned in the 
operation amongst the Kabvlian tribes of Algeria is of special interest, as 
it seems to strengthen, by analogy, the theory that the subjects of prehis¬ 
toric trephining acquired thereby a sacred character which led to the wear¬ 
ing of amulets from their skulls, as already described. 

The curious suggestion has been made that the tonsure of priests is a 
perpetuation of the ancient custom of trephining. The Abbe Martigny, in 
his Dictionary of Christian Antiquities, says that the oldest Christian 
mosaics and manuscripts represent St. Peter with the tonsure as a mark of 
pre-eminence over the other apostles. It is probable that no weight should 
be attached to this fact. The picture galleries of Europe abound in Holy 
Families where tonsured monks of various orders are adoring the infant 
Christ—anachronisms which did not trouble the old masters. We know, 
too, that Brahmin priests, of a period long anterior to the Christian era, 
are represented as tonsured. This does not, of course, affect the question 
of the possible origin of the tonsure from the supposed sacred custom of 
trephining, but the matter may be safely left as unsettled. 

The discoveries which have been made of late in mapping out the 
convolutions of the brain, or, as it is termed, the localization of function, 
have led to the reintroduction of trephining from a highly scientific stand- 

■ |6 Native medicine and surgery in the South Sea Islands, by the Rev. Samuel Ella. Med. Times & 
Gaz., Loud., 1874, i, 50. 








V. S. G. AND G. SURVEY. 


PREHISTORIC TREPHINING , PI. IX. 



Cranium artificially trephined by M. Championni6re. 




FLETCHER. J 


CONCLUSIONS. 


29 


point. Given, in injury of the head or abscess of the brain, the failure of a 
function, the locality of that function being known, there is the place to 
trephine. Some very remarkable results have been attained, and the con¬ 
sequence is that trephining has again become popular in France Broca 
deserves the credit of being among the first to initiate this method of tre¬ 
phining. 47 This matter is referred to because a distinguished French surgeon, 
M. Lucas-Championnikre, published a work upon the subject about four 
years ago, and in the introduction, speaking of prehistoric trephining, he 
takes the ground that the operation was not performed by scraping, as Broca 
supposed, but by a series of punctures such as have been described as pro¬ 
duced by the Algerian operator. 48 To prove this, he took a flint weapon, and 
drilling a series of holes in a skull, afterwards ran them one into the other 
and removed the piece. The serrations were easily smoothed off with a 
piece of flint. The result could not be distinguished from the opening pro¬ 
duced by scraping, the beveled edges being alike. (See Plate IX.) 

This is ingenious and surprising; but while it must be admitted that 
the perforations may have been made by puncture, yet the existence of a 
considerable number of skulls partially trephined, the outer table only 
having been unmistakably scraped away, offers a strong presumption in 
favor of the latter method. 

The following conclusions may be permitted: 

1. The large number of perforated neolithic crania exhibiting cicatrized 
edges establishes the existence of a custom of trephining. 

2. The operation was performed on both sexes, and generally at an 
early age. 

3. The purpose is doubtful, but from analogy it would seem to have 
been for the relief of disease of brain, injury of skull, epilepsy or convul¬ 
sions. 

4. The operation was probably performed by scraping; possibly by a 
series of punctures. It is likely that the first was employed for children 
and the latter for the harder skulls of adults. 

47 M. Legouest, the professor of military surgery at Val tie Grace, formulates this remarkable 
rule: “Singular as it may appear, I think the rule is that you should always trephine when you are 
doubtful whether it ought to be done ”! 

^fitnde historique et clinique sur la trepanation du crane; la trepanation guitiee par les localisa¬ 
tions c^rebrales. Par Just Lucas-Championnibre. Paris, 1878. 8°, p. 12. 



30 


PREHISTORIC TREPHINING. 


5. Posthumous trephining consisted in removing fragments of the skull 
of a person who had undergone surgical trephining. 

6. Each fragment was to exhibit a portion of the cicatrized edge of the 
original operation; and the purpose w r as, probably, to form an amulet to 
protect from the same disease or injury for relief of which the operation 
had been performed. 

7. The evidence so far confines the custom to neolithic man on the 
continent of Europe. 

ADDITIONAL NOTE. 

Since the foregoing was printed a curious discovery has been made of 
something like “post-mortem trephining” in a remote region. Dr. Dy- 
bowski, who has been traveling in Yessel and the Aino lands, sent eight 
Aino skulls to Mr. Kopernicki, who observed in five of them that a resection 
of the foramen magnum had been performed in what he described as “a 
systematic manner analogous to the trephined skulls of the French dolmens.” 
In one skull a portion only of the edge of the foramen magnum had been 
cut out; in another the alveolar process had been sawn off. He supposed 
that the purpose of the resection was not ceremonial, but medical, and that 
the excised bone was to be used as a remedy. Nothing is known of trephin¬ 
ing among the Ainos. 

Mr. Kopernicki sent the description of these skulls to the Ethnological 
Society of Berlin, and Professor Virchow remarked that there was no doubt 
that an artificial removal of fragments of bone had taken place, generally 
from the posterior and lateral sections of the border of the foramen mag¬ 
num and the adjacent parts. In the three Aino skulls in his own collection 
nothing of the kind was to be seen, but a Goldi skull and a New Branden¬ 
burg skull presented similar lesions He had supposed them, in the latter 
case, to be due to an attempt to make a drinking-cup of the skull, it having 
been found in the earth without any other parts of a skeleton, and in the 
frontal bone two small holes had been made as if for strings. The five Aino 
skulls in question had been dug out of graves by Dr. Dybowski himself, 
and he did not think the drinking-cup theory was applicable to them. He 
was unable to give any opinion as to the object of these resections. 49 


^Zeitscbrift fur Ethnologic, Berlin, 1881, xiii, 191-192. See, also, foot-note 3, p. 6 ante. 



INDEX 


Pago. 

Additional note. 30 

Aiguidres, Dolmen near. 6 

Aino skulls. 30 

Algeria.15,22,25 

-, Prehistoric trephining in. 22 

America, Prehistoric trephining in. 23 

American Assoc. Adv. Sci. 24 

Amnlets.5, 6,13 

Athene, Birth of. 15 

Babert de Juill6. 17 

Baye, Grottoes of. 16,18 

de Baye. 16 

Beanmes-Chaudes, Caverns of. 18 

Bcinliaus at Sedlec.20, 21 

Belief in future existence indicated by prehistoric 

trephining. 15 

Berbers. 25 

Bilin, Crania from. 24 

BogdanofF, Tumulus at. 22 

Boise, Forest of, Tumulus in. 17 

Bones found inside of crania. 16 

Bougon, Tumulus at. 17 

Boujoussac, Tomb at. 13 

Brain, Localization of function of, applied to trephining. 29 

Bray-sur-Seine (Marne). 18 

Brima, instrument for perforating skull. 26 

Broca, Paul.5, 6,7, 8,9,10,12,14,15,16,22, 29 

Brookville, Ancient cemetery at. 6 

Buckland, Miss A. W . 15 

Bytcliiskala, Grotto of. 19 

Cartailhac, fim. 23 

Casa da Mouva, Grotto of. 23 

Cavalry saber stroke on skull. 9 

Cavern of L’Homme-Mort. 16 

Chauvet. : . 17 

Chouquet. 17 

Cibournios, Dolmen of. 11 

Cicati ization of bone, Indications of. 7 

Cludsef, Ingoald. 21 

Devil River, Mounds at. 25 

Dieli, or price of blood. 27 

Djebel Aourhs. 25 

Dogs, Charm for fits in. 15 

Drinking-cups of skulls. 6, 30 

Dudik, B.20, 21 

Dyaks of Borneo. 24 

Dybowski, Dr. 30 

Denmark, Prehistoric trephining in. 22 

iScuellcs, Mound at. 17 

Ella, Rev. Samuel. 28 

Engelhardt. 22 

Entre Roche, Skull from. 17 

Epilepsy, Remedies for. 14 

-, Trephining for. 14 

Epileptic of the New Testament. 14 

von Erckort, General. 21 


p Pago. 

Esthonian crania. 16 

fitang-la-Yille, Dolmen at. 17 

Faidherbe, General. 22 

Falster, Island of, Skull from. 22 

Foramen magnum, Resection of. 30 

Forehead never trephined. 9 

French Assoc. Adv. Sci.5,13,17 

Furfooz, Crania from. 16 

Gassies. 17 

Germany, Prehistoric trephining in.19, 20, 21, 22 

Gilman, Henry. 24, 25 

Goldi skull . 30 

Great Britain, No prehistoric trephining in. 22 

Gu6gan.. 17 

Hephaestus. 15 

Holbrook, W. C. 25 

Horses killed by pole-axe, Skulls of. 20 

Hussites, Slaughter at Sedlec by .. 20 

Inca skull from Peru. 23 

Internal. Cong. Prehist. Anthrop. 16 

Italian Society of Ani hrop. 22 

Italy, Prehistoric trephining in. 22 

Ivory-like surface of cicatrized bone. 7,11 

Kabyles of Constantino.'.. 25 

-, Trephining practiced by.25,26, 27 

Kopemicki. 30 

La Lozfere, Dolmens of.. 5,12,13,16, 18, 20 

Lagneau, G. A. 10 

Langdon, F. "W. 8 

Le Baron, Jules. 9,22 

Legouest. 29 

Lisbon, Museum of. 23 

Livy. 6 

Lucas-Championnidre, J. 29 

Lucian. 15 

McCutchon, P. B. 27 

Madisonville, Prehistoric cemetery at. 8 

Mantegazza. 22 

la Marconi^re, Dolmen at. 13 

Martigny, Abb6. 28 

Martin, L.-T. 25,26,27 

Mason, O. T. 24 

Mauvoisin.. 18 

de Mortillet, A. 16, 23 

Mus6e Broca. 9, 22 

NOlaton. 24 

New Brandenburg skull. 30 

Nicolucci. 22 

Niort. 17 

Noes, Dolmen .at. 22 

Norsemen drinking fiom skulls. 6 

Nott, J. P. 24 

Occipital bone, Trephining on. 9 

Os antiepilcpticum. 14 

Ossa Wormiana.. 14 

Otaheite, Trephining in. 27 


31 






















































































































32 


INDEX 


Page. 

Parietal bones usual site for trephining. 9,25 

Paris, Amedeo.25, 26, 27 

Parrot...9,18,19 

Pruni&res..5,6,11,12,13,16,17,18 

Quatrefages. 16 

Quick, E. It. 6 

Itace in relation to traumatism. 11 

Raclage or scraping. 18 

River Rouge, Mounds at. 24 

Rock River, Mounds at. 25 

Roknia, Skulls from. 22 

Rondelles..5, 6,13,16, 21 

-, Counterfeit. 23 

Sable River, Mounds at. 24 

Schneider, L. 22 

Sedlec Beinhaus. 20, 21 

Skull, Congenital deficiencies of. 9 

-, Injuries of, from blows.. 8,10 

-, Reparative process of wounds of. 10 

-, Trephining of, for disease of bone. 18 

-, Wounds of. 8,9 

Society of Anthropology of Paris.: 6, 9,12,17,18,23 

-of Ethnology of Berlin. 20 

South Sea Islands, Trephining in.12,15,27 

Squier, E. G. 23 

Staggers in sheep cured by trephining. 12 

Strnpcic, Skulls from. 22 


Taxil, Jehan. 

Tertre Guerin, Skulls from. 

Thebibes. 

Tonsure a symbol of trephining. 

Trephining, Incomplete. 

-, Posthumous, on Aino skulls.. 

-, Prehistoric, confined to neolithic age 

-,-, performed on females. 

-,-,-young children.. 

-,-, Methods of. 

-,-, Purpose of.. 

-,-, Posthumous. 

-,-, Surgical. 

-not dangerous per se . 

-performed as a means of extortion ... 

-repeated on same person. 

tJvea, Trephining in.*. 

Vaurdal (Oise), Cranium from. 

Yeckenstedt.. 

Yelpeau.. 

Virchow, Rudolph... 

Wankel, H. 

Wiedersheim, R. 

Woman’s milk as surgical dressing.. 

Zeus, Trephining performed on. 

Ziemcin, Rondelle from. 

Ziska, John. 


Page. 

18 

17 

... 26,27 
28 

18 
30 
16 

9 

10 

11,12,13 
14 
7 
7 


27 

.. 18,27 
... 27,28 
9 
12 
11 

... 21,30 
19, 20, 21 
22 
27 
15 
21 
20 



















































































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